Provider Demographics
NPI:1568855666
Name:WYATT, MARTHA JEAN
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:JEAN
Last Name:WYATT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 L ST NW
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-2919
Mailing Address - Country:US
Mailing Address - Phone:918-852-7743
Mailing Address - Fax:
Practice Address - Street 1:1107 L ST NW
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-2919
Practice Address - Country:US
Practice Address - Phone:918-852-7743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2025-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor